Pre-symptoms of subarachnoid hemorrhage

Written by Wang Li Bing

Intensive Care Medicine Department

Updated on September 08, 2024

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Before a subarachnoid hemorrhage, patients generally do not exhibit obvious symptoms. However, if a patient suddenly experiences severe headaches, nausea, vomiting, and other discomforts, subarachnoid hemorrhage should be suspected. The patient should promptly seek attention and complete a cranial CT scan. If the diagnosis of subarachnoid hemorrhage is confirmed, measures should be taken to dehydrate the patient and reduce intracranial pressure. If the patient has a significant amount of intracranial bleeding, surgical treatment should be considered to remove intracranial hematomas and other proactive managements, while dynamically observing changes in the patient's consciousness and pupils.

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Written by Zhang Hui

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Causes of subarachnoid hemorrhage

Subarachnoid hemorrhage is a very dangerous disease, in which patients experience severe headaches, noticeable nausea, vomiting, restlessness, and agitation. If the bleeding is extensive, the patient can quickly become comatose and may develop serious complications such as cerebral vasospasm and hydrocephalus. Common causes of cerebral hemorrhage include: First, cerebral aneurysms. Cerebral aneurysms are the most common cause of subarachnoid hemorrhage and may be related to congenital developmental abnormalities or acquired factors such as smoking. Second, arteriovenous malformations, which are also a common cause of bleeding. Third, there are other causes, such as trauma or coagulation disorders, and long-term use of anticoagulant medications may also be contributing factors.

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Written by Li Ai Ping

Neurology

51sec

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What to do with a headache from subarachnoid hemorrhage?

Subarachnoid hemorrhage, the most typical symptom of which is headache, often manifests as a sudden severe throbbing or bursting pain. The pain may be localized to a specific area of the head, or it may affect the entire head or neck, and it generally persists continuously. If such a headache occurs, one should first rest in bed, avoid emotional excitement and exerting great force, such as coughing, shouting loudly, or straining during bowel movements, etc. If the pain is unbearable, one can ask a doctor for appropriate pain relief medication. However, if the headache suddenly worsens, one should be cautious of the condition deteriorating and should seek medical advice to investigate the cause of the worsening headache. One should not blindly request medication for pain relief, as it may mask the underlying condition.

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Written by Zhang Hui

Neurology

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Differentiation between subarachnoid hemorrhage and cerebral hemorrhage

Subarachnoid hemorrhage and cerebral hemorrhage, though both involve bleeding, have different mechanisms of onset. The first distinction is that cerebral hemorrhage is generally caused by hypertension. Hypertension leads to hyaline degeneration and fibrinoid necrosis of arteries, resulting in bleeding. In contrast, the most common cause of subarachnoid hemorrhage is an aneurysm, which may be related to factors such as smoking and congenital developmental abnormalities. In terms of clinical presentation, cerebral hemorrhage has a sudden onset, with symptoms of headache, nausea, vomiting, but also includes impairments in language functions, and signs of neurological deficits such as limb paralysis. Subarachnoid hemorrhage, on the other hand, typically involves very severe pain, usually without manifestations such as limb paralysis. Furthermore, from a radiological perspective on CT imaging, cerebral hemorrhage is mainly located in the brain parenchyma, while subarachnoid hemorrhage mainly indicates that the site of bleeding is in the subarachnoid space.

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Written by Liu Yan Hao

Neurology

59sec

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Clinical manifestations of subarachnoid hemorrhage

The clinical manifestations of subarachnoid hemorrhage include severe headache, projectile vomiting, and neck stiffness, sometimes accompanied by disturbances in consciousness. Some describe the headache caused by subarachnoid hemorrhage as the most severe headache of their lives. This severe pain is due to the congestion stimulating the meninges, causing pain that is typically very severe. Because the bleeding into the subarachnoid space allows blood to enter between the pia mater and the arachnoid membrane, stimulating the meninges and leading to these severe headaches, it causes a rapid increase in intracranial pressure and projectile vomiting. Patients may exhibit disturbances in consciousness and symptoms of irritability. This condition is considered a severe medical emergency that requires hospitalization for comprehensive treatment, with strict bed rest for four to six weeks, and it has a very high mortality rate.

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Written by Wang Li Bing

Intensive Care Medicine Department

45sec

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Pre-symptoms of subarachnoid hemorrhage

Before a subarachnoid hemorrhage, patients generally do not exhibit obvious symptoms. However, if a patient suddenly experiences severe headaches, nausea, vomiting, and other discomforts, subarachnoid hemorrhage should be suspected. The patient should promptly seek attention and complete a cranial CT scan. If the diagnosis of subarachnoid hemorrhage is confirmed, measures should be taken to dehydrate the patient and reduce intracranial pressure. If the patient has a significant amount of intracranial bleeding, surgical treatment should be considered to remove intracranial hematomas and other proactive managements, while dynamically observing changes in the patient's consciousness and pupils.